MetaStar 2005 Some is Not a Number. Soon is Not a Time. Carolyn Coffey, BSN, RN, MS, CPHQ Critical Access Hospital Workshop for Nurses December 6, 2005.

MetaStar

2005

Some is Not a Number. Soon is Not a Some is Not a Number. Soon is Not a Time.Time.

Carolyn Coffey, BSN, RN, MS, CPHQCarolyn Coffey, BSN, RN, MS, CPHQ

Critical Access Hospital Critical Access Hospital

Workshop for NursesWorkshop for Nurses

December 6, 2005December 6, 2005

MetaStar

2005

ObjectivesObjectives

Save 100,000 lives over the next 18 months Save 100,000 lives over the next 18 months Enroll as many as 2,000 hospitalsEnroll as many as 2,000 hospitals Hospitals adopt 6 evidence based changesHospitals adopt 6 evidence based changes

Build a reusable national infrastructure for Build a reusable national infrastructure for changechange

MetaStar

2005

The six changesThe six changes

Deployment of rapid response teamsDeployment of rapid response teams Delivery of reliable, evidence-based care Delivery of reliable, evidence-based care

for acute myocardial infarctionfor acute myocardial infarction Prevention of central line infectionsPrevention of central line infections Prevention of surgical site infectionsPrevention of surgical site infections Prevention of ventilator-associated Prevention of ventilator-associated

pneumoniapneumonia Prevention of adverse drug eventsPrevention of adverse drug events

MetaStar

2005

Infrastructure for changeInfrastructure for change

NodesNodes Geographic node—WI NodeGeographic node—WI Node Organizational nodes—Ascension HealthOrganizational nodes—Ascension Health Affinity nodesAffinity nodes

Childrens’ hospitalsChildrens’ hospitals Rural hospitals Rural hospitals

Non-exclusivityNon-exclusivity Take all comersTake all comers

MetaStar

2005

Campaign statisticsCampaign statistics

Began December 14, 2005, 9:00 a.m. (ET)Began December 14, 2005, 9:00 a.m. (ET) ““Ends" June 14, 2006, 9:00 a.m. (ET)Ends" June 14, 2006, 9:00 a.m. (ET) Over 2,900 hospitals currently participatingOver 2,900 hospitals currently participating Over 70 Wisconsin hospitals participatingOver 70 Wisconsin hospitals participating

MetaStar

2005

MetaStar

2005

Node responsibilities Node responsibilities

Disseminate improvement tools Disseminate improvement tools Provide support to health care providers Provide support to health care providers

throughout Wisconsin throughout Wisconsin Encourage other hospitals to join the Encourage other hospitals to join the

campaign and to participate in improvement campaign and to participate in improvement efforts associated with the campaignefforts associated with the campaign

MetaStar

2005

Node responsibilities Node responsibilities (cont)(cont)

Act as a communication point between the Act as a communication point between the hospitals in the campaign and the national hospitals in the campaign and the national campaigncampaign

Respond to emerging issues during the Respond to emerging issues during the course of the campaigncourse of the campaign

Track and support hospitals in measure Track and support hospitals in measure campaign progresscampaign progress

MetaStar

2005

Wisconsin Node activitiesWisconsin Node activities

Conducted survey of participating hospitalsConducted survey of participating hospitals MetaStar’s assistance under its CMS MetaStar’s assistance under its CMS

contractcontract MetaStar’s Central Line Infection InitiativeMetaStar’s Central Line Infection Initiative WHA/PSW Medication Reconciliation WHA/PSW Medication Reconciliation

ProjectProject WONE Rapid Response Team workWONE Rapid Response Team work

MetaStar

2005

InterventionIntervention

Fully Fully Implemented Implemented (6/05)(6/05)

AMI CareAMI Care 56%56%

Surgical Infection PreventionSurgical Infection Prevention 32%32%

Medication ReconciliationMedication Reconciliation 26%26%

VAP Prevention VAP Prevention 15%15%

CLI PreventionCLI Prevention 13%13%

Rapid Response TeamRapid Response Team 9%9%

* N = 52-54* N = 52-54

MetaStar

2005

Of the six changes, Of the six changes, establishing rapid response establishing rapid response teams has the potential to teams has the potential to save the most lives—60,000 save the most lives—60,000 of the 100,000 lives—but of the 100,000 lives—but

has the lowest has the lowest implementation rate—9% of implementation rate—9% of Wisconsin hospitals are Wisconsin hospitals are

fully implementedfully implemented

MetaStar

2005

Deployment of Deployment of rapid response teams (RRTs)rapid response teams (RRTs)

Team of clinicians (doctors, nurses, Team of clinicians (doctors, nurses, respiratory therapists, etc.) who bring respiratory therapists, etc.) who bring intensive care expertise to the patient intensive care expertise to the patient bedside (or wherever it is needed).bedside (or wherever it is needed).

Goal: To respond to the signs and Goal: To respond to the signs and symptoms of the patient’s worsening symptoms of the patient’s worsening condition condition beforebefore the patient’s heart or the patient’s heart or breathing stopsbreathing stops

MetaStar

2005

Wisconsin Node support for Wisconsin Node support for rapid response teams rapid response teams

Led by the Wisconsin Organization of Nurse Led by the Wisconsin Organization of Nurse Executives and The Dahlen CompanyExecutives and The Dahlen Company

Established a steering committeeEstablished a steering committee Prepared a sample intervention timeline for Prepared a sample intervention timeline for

hospitals considering starting an RRThospitals considering starting an RRT Using RWHC’s quality round tables to Using RWHC’s quality round tables to

discuss implementation issues discuss implementation issues

MetaStar

2005

Wisconsin Node support for Wisconsin Node support for rapid response teams (cont)rapid response teams (cont)

Calls to hospitals by The Dahlen CompanyCalls to hospitals by The Dahlen Company Posting list of hospitals that have Posting list of hospitals that have

implemented RRT on WI Node websiteimplemented RRT on WI Node website Posting contact information for help Posting contact information for help Posting tips for those that are stalledPosting tips for those that are stalled

MetaStar

2005

Bundle for delivery of Bundle for delivery of reliable, evidence-based care reliable, evidence-based care

for AMIfor AMI Early administration of aspirinEarly administration of aspirin Aspirin at dischargeAspirin at discharge Early administration of beta-blockerEarly administration of beta-blocker Beta-blocker at dischargeBeta-blocker at discharge ACE-inhibitor or ARB at discharge for ACE-inhibitor or ARB at discharge for

patients with systolic dysfunctionpatients with systolic dysfunction Timely initiation of reperfusion Timely initiation of reperfusion Smoking cessation counselingSmoking cessation counseling

MetaStar

2005

What’s a bundle?What’s a bundle?

Measure of performance of evidenced based Measure of performance of evidenced based practices vs. opportunitypractices vs. opportunity

Patient centeredPatient centered All or nothingAll or nothing

MetaStar

2005

WI Node support for AMIWI Node support for AMI

AMI webinar November 2006 AMI webinar November 2006 MetaStar work on appropriate care measures MetaStar work on appropriate care measures

(ACM) aligns with 100k Lives AMI bundle(ACM) aligns with 100k Lives AMI bundle CAH Project Planning Conference CallsCAH Project Planning Conference Calls

December 5, 3-4 PMDecember 5, 3-4 PM December 12, 12-1 PM December 12, 12-1 PM

Special AMI measures for CAH—Fall 2006Special AMI measures for CAH—Fall 2006 Working to report ACM bundle on CheckpointWorking to report ACM bundle on Checkpoint

MetaStar

2005

Prevention of Prevention of central line infections bundlecentral line infections bundle

Hand hygieneHand hygiene Maximal barrier precautionsMaximal barrier precautions Chlorhexidine skin antisepsisChlorhexidine skin antisepsis Optimal catheter site selectionOptimal catheter site selection Daily review of line necessity, with prompt Daily review of line necessity, with prompt

removal of unnecessary lines removal of unnecessary lines

MetaStar

2005

WI Node work on central line WI Node work on central line infection preventioninfection prevention

MetaStar’s Central Line Infection InitiativeMetaStar’s Central Line Infection Initiative 16 hospitals participated16 hospitals participated Goals: Goals:

To reduce the number of central line infections To reduce the number of central line infections in participating hospitals to zero in participating hospitals to zero

To understand the economic impact of central To understand the economic impact of central line infectionsline infections

MetaStar

2005

MetaStar Central Line MetaStar Central Line Infection Initiative (cont)Infection Initiative (cont)

FormatFormat What can you do in 90 days?What can you do in 90 days? One Learning Session: June 27, 2005One Learning Session: June 27, 2005 Monthly conference callsMonthly conference calls

ProcessProcess Adopt the central line bundleAdopt the central line bundle

MetaStar

2005

Prevention of Prevention of surgical site infections (SSI)surgical site infections (SSI)

Appropriate use of antibioticsAppropriate use of antibiotics Appropriate hair removalAppropriate hair removal Maintenance of postoperative glucose control Maintenance of postoperative glucose control

for major cardiac surgery patientsfor major cardiac surgery patients Establishment of postoperative normothermia Establishment of postoperative normothermia

for colorectal surgery patientsfor colorectal surgery patients

MetaStar

2005

WI Node work for SSIWI Node work for SSI

MetaStar’s new QIO contract aligns with MetaStar’s new QIO contract aligns with 100k Lives Campaign goals. Project work 100k Lives Campaign goals. Project work on the surgical care improvement project on the surgical care improvement project (SCIP) aligns with the 100k Lives SSI(SCIP) aligns with the 100k Lives SSI

SSI—MetaStar planned webinar in JanuarySSI—MetaStar planned webinar in January

MetaStar

2005

Prevention of Prevention of adverse drug events (ADEs) by adverse drug events (ADEs) by

implementing medication implementing medication reconciliationreconciliation

Step 1: Verification Step 1: Verification

Step 2: Clarification Step 2: Clarification

Step 3: ReconciliationStep 3: Reconciliation

MetaStar

2005

WI Node work to support WI Node work to support medication reconciliationmedication reconciliation

Led by the Wisconsin Hospital Association Led by the Wisconsin Hospital Association and the Pharmacy Society of Wisconsinand the Pharmacy Society of Wisconsin Developing tools to assist implementationDeveloping tools to assist implementation Tools posted on WI Node websiteTools posted on WI Node website

Developed a medication reconciliation Developed a medication reconciliation measure for use with in the CheckPoint measure for use with in the CheckPoint public reporting initiativepublic reporting initiative

MetaStar

2005

Bundle for prevention of Bundle for prevention of ventilator-associated ventilator-associated

pneumonia (VAP)pneumonia (VAP) Elevation of the head of the bed to between 30 Elevation of the head of the bed to between 30

and 45 degreesand 45 degrees Daily “sedation vacation” and daily Daily “sedation vacation” and daily

assessment of readiness to extubateassessment of readiness to extubate Peptic ulcer disease (PUD) prophylaxisPeptic ulcer disease (PUD) prophylaxis Deep venous thrombosis (DVT) prophylaxis Deep venous thrombosis (DVT) prophylaxis

(unless contraindicated)(unless contraindicated)

MetaStar

2005

WI Node work on VAPWI Node work on VAP

MetaStar VAP webinar December 5, 2005, MetaStar VAP webinar December 5, 2005, 12:00 – 1:00 p.m.12:00 – 1:00 p.m.

VAP a SCIP moduleVAP a SCIP module

MetaStar

2005

Node CommunicationsNode Communications

E-mailsE-mails NewslettersNewsletters Teleconferences/WebinarsTeleconferences/Webinars ConferencesConferences Phone callsPhone calls Speaking engagementsSpeaking engagements Wisconsin Node website: Wisconsin Node website: http://www.metastar.com/professional/IHI100kLives.asphttp://www.metastar.com/professional/IHI100kLives.asp

MetaStar

2005

Wisconsin CAH experiences on Wisconsin CAH experiences on the 100k Lives journeythe 100k Lives journey

MetaStar

2005

Questions?Questions?

MetaStar

2005

Contact Information:Contact Information:MetaStar, Inc.MetaStar, Inc.2909 Landmark Place2909 Landmark PlaceMadison, WI 53713Madison, WI 537131-800-362-23201-800-362-2320

www.metastar.comwww.metastar.com

Carolyn CoffeyCarolyn [email protected]@metastar.com